Cleft Lip/Cleft Palate

One of the most common congenital problems that occur in newborn infants are cleft deformities: cleft lip and cleft palate. They result from incomplete development of the lip or the palate during pregnancy. Though these congenital problems have been studied extensively, it is still not know exactly what causes them. It is however well understood that they are not due to something particular that the mother did during pregnancy. Proper care of an infant with a cleft deformity may involve the help of a variety of health professionals. In addition to surgery to repair the defects there may be other associated issues. Speech and hearing may be effected, requiring the care of an otolaryngologist and a speech pathologist. Dentition may be effected also, requiring the care of an orthodontist specialized in this type of care. Many University Hospitals have Orofacial Teams that work with children with cleft deformities. The team approach to management is ideal for the child and the parents.

When will the repairs take place?

Initial closure of the cleft lip takes place at 2-4 weeks of age. This surgery is done as an outpatient. The more detailed repair takes place at 4-6 months of age. This is also done as an outpatient procedure. The palate is repaired at approximately 18 months of age. This surgery requires at least one night in the hospital. It is important to be sure that your child is well hydrated and able to eat prior to discharge.

Where are the incisions placed?

With lip repair an incision is placed from the lip up toward the nose. It is visible and will fade with time.

What happens the first day or two after surgery?

Your child will be placed in "no-no" restraints. These are soft restraints that prohibit your child from bending her elbows. The surgical repair can be destroyed easily by the insertion of a fist in the mouth or by picking or rubbing the lips. The outside sutures will be removed at 4-5 days and replaced with as small tape dressing. This will fall off on its over the next few days. Internal sutures will dissolve spontaneously and do not need to be removed.

Your child may be a bit cranky the first day or two. Discomfort can be easily controlled with pain medication.

What complications are possible?

As with nearly any surgery, delayed healing or infection is a risk. In rare cases there may be poor healing of the palate, which may lead to the need for a second surgical repair.

Will my baby's feeding be affected?

Feeding a baby with a cleft lip or palate can present a large challenge to the mother. When a cleft lip is present it is hard for the baby to close tightly around the nipple. When a cleft palate is present the baby has difficulty sucking. Because of this the following things may happen:

• Feeding will take longer, resulting in a tired and irritable baby
• Excess air may be swallowed resulting in stomach discomfort, vomiting or spitting up
• Food may be lost through the nose resulting in irritation-Food may go into the trachea resulting in coughing or choking.
• Your baby may not get enough milk or formula resulting in a failure to gain weight and hunger

Your doctor should provide you with detailed information about feeding. The Orofacial Team will have a nurse specialist who can assist you.